| NPI | 1346382835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MA 231599) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 231599) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2016-12-08 |